Psychometric analyses of different rating scales have shown that the construct validity of depression in relation to patients from other cultural backgrounds than Western is unclear. This calls for more knowledge on the qualitative properties of depression in a transcultural context. The aim of the study was to examine how Arabic speaking patients understand and speak about mental distress, while also exploring to what degree they find depressive symptoms as defined in the ICD-10 and selected rating scales meaningful. Six semi-structured interviews with Arabic speaking patients from Syria, Lebanon and Iraq receiving treatment at a Danish treatment centre were conducted. Data was analysed by the use of thematic analysis. Various Arabic terms in relation to a state comparable to depression were obtained, especially in relation to the core depressive symptoms of “low mood”, “low energy” and “loss of interest”. Symptoms regarding guilt and loss of self-confidence were not recognized as a part of a depressive state to the same degree as the other depressive symptoms. Some symptoms, such as somatic complaints, were more accepted to speak openly about than others. It was concluded that the participants in the study generally recognized the depressive symptoms as defined in the ICD-10 and would use comparable Arabic terms to describe mental distress. However, cultural background may influence to what extend depression is accepted to speak about, which should thus be taken into consideration and addressed by mental health professionals. In a clinical setting, this knowledge can be used to include culture specific terms and phrases in the conversations with Arabic speaking patients.
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Al-Issa, I. (2000). Mental illness in medieval Islamic society. In In: Al-Junun, mental illness in the Islamic world. Madison: International Universities Press.
Bagby, R. M., Ryder, A. G., Schuller, D. R., & Marshall, M. B. (2004). The Hamilton depression rating scale: Has the gold standard become a Lead weight? American Journal of Psychiatry, 161(12), 2163–2177 https://doi.org/10.1176/appi.ajp.161.12.2163.
Bech, P. (2011). The ABC profile of the HAM-D17. Revista brasileira de psiquiatria (São Paulo, Brazil : 1999), 33, 109–110 https://doi.org/10.1590/S1516-44462011000200001.
Bener, A., & Ghuloum, S. (2011). Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. International Journal of Social Psychiatry, 57(5), 480–486 https://doi.org/10.1177/0020764010374415.
Bracken, P., Giller, J., & Summerfield, D. (1995). Psychological responses to war and atrocity: The limitations of current concepts. Social Science & Medicine, 40(8), 1073–1082 https://doi.org/10.1016/0277-9536(94)00181-R.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101 https://doi.org/10.1191/1478088706qp063oa.
Burr, V. (2015). Social constructionism. London, UNITED KINGDOM: Routledge.
Caroppo, E., Muscelli, C., Brogna, P., Paci, M., Camerino, C., & Bria, P. (2009). Relating with migrants: Ethnopsychiatry and psychotherapy. Annali dell Istituto Superiore di Sanita, 45(3), 331–340.
El-Islam, M. F. (1982). Arabic cultural psychiatry. Transcultural Psychiatric Research Review, 19(1), 5–24 https://doi.org/10.1177/136346158201900101.
Eurostat (2020, April 2nd): Asylum and first time asylum applicants by citizenship, age and sex. Annual aggregated data (rounded). Retrieved April 17th 2020 from: https://appsso.eurostat.ec.europa.eu/nui/show.do?query=BOOKMARK_DS-057066_QID_-5C5B0FBF_UID_-3F171EB0&layout=TIME,C,X,0;GEO,L,Y,0;CITIZEN,L,Z,0;SEX,L,Z,1;AGE,L,Z,2;ASYL_APP,L,Z,3;UNIT,L,Z,4;INDICATORS,C,Z,5;&zSelection=DS-057066CITIZEN,EXT_EU28;DS-057066UNIT,PER;DS-057066ASYL_APP,NASY_APP;DS-057066INDICATORS,OBS_FLAG;DS-057066SEX,T;DS-057066AGE,Y_LT18;&rankName1=UNIT_1_2_-1_2&rankName2=AGE_1_2_-1_2&rankName3=CITIZEN_1_2_-1_2&rankName4=INDICATORS_1_2_-1_2&rankName5=ASYL-APP_1_2_-1_2&rankName6=SEX_1_2_-1_2&rankName7=TIME_1_0_0_0&rankName8=GEO_1_2_0_1&sortC=ASC_-1_FIRST&rStp=&cStp=&rDCh=&cDCh=&rDM=true&cDM=true&footnes=false&empty=false&wai=false&time_mode=ROLLING&time_most_recent=false&cfo=%23%23%23%2C%23%23%23.%23%23%23&lang=en.
Haroz, E. E., Ritchey, M., Bass, J., Kohrt, B. A., Augustinavicius, J., Michalopoulos, L., et al. (2017). How is depression experienced around the world? A systematic review of qualitative literature. Social Science & Medicine, 183, 151–162 https://doi.org/10.1016/j.socscimed.2016.12.030.
Islam, F., & Campbell, R. (2014). “Satan has afflicted me!” jinn-possession and mental illness in the Qur’an. Journal of Religion and Health, 53(1), 229–243 https://doi.org/10.1007/s10943-012-9626-5.
Kaiser, B., Haroz, E. E., Kohrt, B. A., Bolton, P. A., Bass, J., & Hinton, D. (2015). “Thinking too much”: A systematic review of a common idiom of distress. Social Science & Medicine, 147, 170–183 https://doi.org/10.1016/j.socscimed.2015.10.044.
Killikelly, C., & Maercker, A. (2018). Prolonged grief disorder for ICD-11: The primacy of clinical utility and international applicability. European Journal of Psychotraumatology, 8(6), 1–9 https://doi.org/10.1080/20008198.2018.1476441.
Kirmayer, L. J. (1984). Culture, affect and somatization: Part I. Transcultural Psychiatric Research Review, 21(3), 159–188 https://doi.org/10.1177/136346158402100301.
Kirmayer, L. J. (1989). Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine, 29(3), 327–339 https://doi.org/10.1016/0277-9536(89)90281-5.
Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: Implications for diagnosis and treatment. The Journal of Clinical Psychiatry, 62(suppl 13), 22–28.
Kirmayer, L. J. (2007). Cultural psychiatry in historical perspective. In: D. Bhugra & K. Bhui (red.), Textbook of cultural psychiatry (pp. 3–19). https://doi.org/10.1017/CBO9780511543609.003.
Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60(4), 420–430.
Klass, D. (2013). Sorrow and solace: Neglected areas in bereavement research. Death Studies, 37(7), 597–616 https://doi.org/10.1080/07481187.2012.673535.
Kleinman, A. (1977). Depression, somatization and the “new cross-cultural psychiatry”. Social Science & Medicine (1967), 11(1), 3–9 https://doi.org/10.1016/0037-7856(77)90138-X.
Kleinman, A. (1980). Patients and healers in the context of culture, an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, Calif: University of California Press.
Kleinman, A. (1991). Rethinking psychiatry, from cultural category to personal experience (Paperback ed.). New York: Free Press.
Marsella, A., J., Sartorius, N., Jablensky, A., & Fenton, F., R. (1985). Cross-cultural studies of depressive disorders: An overview. In: A. Kleinman & B. Good, Culture and depression, studies in the anthropology and cross-cultural psychiatry of affect and disorder (pp. 299–323). Berkeley, Calif: University of California Press.
Ministry of Immigration and Integration. (2018, January 3rd ). Danmark fik i 2017 det laveste antal asylansøgere i ni år—Udlændinge- og Integrationsministeriet. Retrieved March 19th 2019 from: http://uim.dk/nyheder/2018/2018-01/danmark-fik-i-2017-det-laveste-antal-asylansogere-i-ni-ar/newsitem_view?success=yes
Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard trauma questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180(2), 111–116.
Rasmussen, A., Keatley, E., & Joscelyne, A. (2014). Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature. Social Science & Medicine, 109, 44–54 https://doi.org/10.1016/j.socscimed.2014.03.015.
Sayed, M. (2003). Conceptualization of mental illness within Arab cultures: Meeting challenges in cross-cultural settings. Social Behavior and Personality, 31(4), 333–342 https://doi.org/10.2224/sbp.2003.31.4.333.
Scheper-Hughes, N., & Lock, M. M. (1987). The mindful body: A prolegomenon to future work in medical anthropology. In Medical anthropology quarterly, 1(1), 6–41 (Vol. 1, pp. 6–41). Retrieved from: JSTOR.
Statistics Denmark (n.d.): Asylansøgere efter asyltype, statsborgerskab og tid. Retrieved April 2nd 2020 from: https://www.statistikbanken.dk/statbank5a/selectvarval/saveselections.asp.
Sulaiman, S. O. Y., Bhugra, D., & de Silva, P. (2001). The development of a culturally sensitive symptom checklist for depression in Dubai. Transcultural Psychiatry, 38(2), 219–229 https://doi.org/10.1177/136346150103800205.
Turrini, G., Purgato, M., Ballette, F., Nosè, M., Ostuzzi, G., & Barbui, C. (2017). Common mental disorders in asylum seekers and refugees: Umbrella review of prevalence and intervention studies. International Journal of Mental Health Systems, 11(1), 1–14 https://doi.org/10.1186/s13033-017-0156-0.
White, G. M. (1992). Ethnopsychology. In: T. Schwartz, G. M. White, & C. A. Lutz (red.), New directions in psychological anthropology (pp. 21–46). Cambridge: Cambridge University press.
World Health Organization. (n.d.). ICD-10 Version:2016. Retrieved December 26th 2018 from: https://icd.who.int/browse10/2016/en#/F30-F39
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in acccordance with the ethical standards of the institutional and national research committee.
Ethics approval was not obtained for the study since the study was of a qualitative nature (interviews) and did not include human biological material. Under these circumstances, ethics approval is not required in Denmark. See link: http://en.nvk.dk/how-to-notify/what-to-notify.
In the link, it is described that questionnaires and interviews should not be notified to a research ethics committee.
Informed consent was obtained from all individual participants included in the study.
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Vink, H., Carlsson, J., Poulsen, S. et al. Comparing Western symptoms of depression with Arabic idioms of distress: A qualitative study. Curr Psychol (2020). https://doi.org/10.1007/s12144-020-00829-7
- Transcultural psychiatry
- Idioms of distress
- Local concepts
- Mental health
- Mental disorder